1
|
Fichtner A, Marx A, Ströbel P, Bremmer F. Primary germ cell tumours of the mediastinum: A review with emphasis on diagnostic challenges. Histopathology 2024; 84:216-237. [PMID: 37994540 DOI: 10.1111/his.15090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 11/24/2023]
Abstract
This article will review current aspects of the histopathological, immunohistochemical and molecular analysis of primary mediastinal germ cell tumours (PMGCTs) as well as their aetiological, epidemiological, clinical and therapeutic features. PMGCTs represent an important differential diagnosis in the spectrum of mediastinal tumours, and their diagnosis is usually made on small tissue samples from core needle biopsies in combination with diagnostic imaging and serum tumour markers. As in lymphomas, a small biopsy is often the only viable tumour sample available from these patients, as they receive chemotherapy prior to eventual surgical resection. Pathologists therefore need to apply an efficient combination of immunohistochemical markers to confirm the diagnosis of a PMGCT and to exclude morphological mimics.
Collapse
Affiliation(s)
- Alexander Fichtner
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Alexander Marx
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Felix Bremmer
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
2
|
Weissferdt A. Combined Thymic Epithelial Neoplasms - a Review. Int J Surg Pathol 2023; 31:917-926. [PMID: 36036356 DOI: 10.1177/10668969221118324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thymic epithelial neoplasms are the most common tumors of thymic origin but are overall rare in the general population. Their morphologic diversity, ranging from low grade to overtly malignant lesions, along with various histologic growth patterns make them a diagnostically challenging group of tumors. Very occasionally, thymomas and thymic carcinomas may develop in combination with other benign or malignant lesions of thymic origin, further complicating the diagnostic process. The focus of this review lies on the spectrum of thymic epithelial tumors that present with other thymic lesions in the same tumor mass, such as multilocular thymic cysts, neuroendocrine neoplasms, lymphomas, and germ cell tumors among others. Awareness of the existence of such unusual tumors may not only aid in their diagnosis but may also have implications for prognostic and therapeutic purposes.
Collapse
Affiliation(s)
- Annikka Weissferdt
- Department of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
3
|
Sohn A, Moran CA. Primary mediastinal germ cell tumors. Semin Diagn Pathol 2023; 40:37-46. [PMID: 35717316 DOI: 10.1053/j.semdp.2022.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/09/2022] [Indexed: 01/28/2023]
Abstract
Mediastinal germ cell tumors share similar histopathological, immunohistochemical, and molecular features with their counterparts in the gonads. Therefore, proper clinical and radiological evaluation of patients with an anterior mediastinal mass becomes essential in the final interpretation of these tumors. The gold standard for the diagnosis of these tumors remains histopathological evaluation. However, immunohistochemical stains and molecular studies also provide an aid in cases in which the histology is not typical. It is also important to keep in mind that a small mediastinoscopic biopsy may not be representative of the entire neoplasm. In this review, we will provide our perspective regarding histopathological diagnosis, staging, immunohistochemical and molecular profile, and briefly family of tumors address pertinent epidemiological, clinical and treatment options. However, the main emphasis is to review the process of pathological assessment in pre and post-treated tumors. Knowledge of the different growth patterns and histological associations is important, mainly when confronted with mediastinoscopic biopsies, which ultimately will determine treatment options.
Collapse
Affiliation(s)
- Aaron Sohn
- Departments of Pathology, The University of Texas, M D Anderson Cancer Center, Houston, TX, USA
| | - Cesar A Moran
- Departments of Pathology, The University of Texas, M D Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
4
|
El-Zaatari ZM, Ro JY. Mediastinal Germ Cell Tumors: A Review and Update on Pathologic, Clinical, and Molecular Features. Adv Anat Pathol 2021; 28:335-350. [PMID: 34029275 DOI: 10.1097/pap.0000000000000304] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mediastinal germ cell tumors (MGCTs) are the most common extragonadal germ cell tumors (GCTs) and most often arise in the anterior mediastinum with a male predilection. MGCTs also have a predilection for patients with Klinefelter syndrome and possibly other genetic conditions. MGCTs, as GCTs at other extragonadal sites, are thought to arise from germ cells improperly retained during migration along the midline during embryogenesis. Similar to their counterparts in the testes, MGCTs are classified into seminomatous and nonseminomatous GCTs. Seminomatous MGCT represents pure seminoma, whereas nonseminomatous MGCTs encompass pure yolk sac tumors, embryonal carcinoma, choriocarcinoma, mature or immature teratoma, and mixed GCTs with any combination of GCT types, including seminoma. Somatic-type or hematologic malignancies can also occur in association with a primary MGCT. MGCTs share molecular findings with GCTs at other sites, most commonly the presence of chromosome 12p gains and isochromosome i(12p). Treatment includes neoadjuvant chemotherapy followed by surgical resection of residual tumor, with the exception of benign teratomas, which require only surgical resection without chemotherapy. In this review, we highlight and provide an update on pathologic, clinical, and molecular features of MGCTs. Immunohistochemical profiles of each tumor type, as well as differential diagnostic considerations, are discussed.
Collapse
Affiliation(s)
- Ziad M El-Zaatari
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
- Weill Medical College of Cornell University (WCMC), New York, NY
| |
Collapse
|
5
|
Weissferdt A, Kalhor N, Rodriguez Canales J, Fujimoto J, Wistuba II, Moran CA. Primary Mediastinal Yolk Sac Tumors: An Immunohistochemical Analysis of 14 Cases. Appl Immunohistochem Mol Morphol 2019; 27:125-133. [DOI: 10.1097/pai.0000000000000442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
6
|
Abstract
Tumors arising from urachus in children are exceedingly rare and sporadically reported in literature. Being a midline structure, the urachus may harbor neoplastic germ cell elements and can occasionally present as a case of acute abdomen. A 20-month-old toddler presented with spontaneous rupture of an urachal yolk sac tumor causing hemoperitoneum. He underwent resection, received platinum-based chemotherapy and presently remains well on follow-up. Despite its rarity, urachal germ cell tumors must be considered in a child with acute abdomen and tumor markers must be measured preemptively in such cases.
Collapse
|
7
|
Adenomatoid Spindle Cell Thymomas: A Clinicopathological and Immunohistochemical Study of 20 Cases. Am J Surg Pathol 2010; 34:1544-9. [DOI: 10.1097/pas.0b013e3181f085c5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Diagnostic Utility of Novel Stem Cell Markers SALL4, OCT4, NANOG, SOX2, UTF1, and TCL1 in Primary Mediastinal Germ Cell Tumors. Am J Surg Pathol 2010; 34:697-706. [DOI: 10.1097/pas.0b013e3181db84aa] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
9
|
Saint-Blancard P, Harket A, Bonnichon A, Jancovici R. [Neurogenic spindle-cell tumors of the mediastinum: two cases]. Presse Med 2007; 37:229-34. [PMID: 17988829 DOI: 10.1016/j.lpm.2007.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 05/20/2007] [Accepted: 05/25/2007] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Neurogenic tumors can develop from neural cells in any location. They are commonly found, however, in the mediastinum, most often in its posterior compartment. Neurogenic tumors can be benign or malignant. In the anterior compartment, they must be distinguished from their differential diagnoses. CASES We report one case of a malignant peripheral nerve sheath tumor in the posterior mediastinum of a 29-year-old man and another of a schwannoma of the anterior mediastinum, in an 82-year-old woman. DISCUSSION Neurogenic tumors of spindle-shaped cells in the mediastinum are generally benign, but can be malignant. Often asymptomatic, they are usually detected on standard pulmonary radiography, but computerized tomography is necessary, supplemented by magnetic resonance imaging, especially for posterior mediastinal tumors, to provide additional information and to assess its possible extension to adjacent structures. Radiographic, clinical, and especially histopathological features are essential for diagnosis.
Collapse
Affiliation(s)
- Patrick Saint-Blancard
- Service d'anatomie et de cytologie pathologiques, Hôpital d'instruction des Armées Percy, F-92140 Clamart, France.
| | | | | | | |
Collapse
|
10
|
Abstract
Germ Cell Tumors (GCT) represent an important group of mediastinal tumors. Because of genetic characteristics and behavior have been divided in prepubertal and postpubertal tumors, and their origin remains controversial. The genetic changes are diverse, but the most frequent is i (12p), and can be associated to gonadal disgenesis. Histological classification is similiar to that of gonadal tumors and all histological types have been described in the mediastinum. Teratomas may undergo malignant transformation with the emergence of somatic tumors such as haematological malignancies, sarcomas, carcinomas and neurogenic tumors, and such transformation may occur in the primary site or in the metastases. Prognostic factors in mediastinal germ cell tumors include: age of the patient, histological type, distant metastases, stage, status of resection, level of serum tumor markers and proliferation markers. Immunohistochemistry is especially useful when the primary GCT is occult, to separate types of immature GCT, and to determine the lineage of malignant transformation which may be important to design treatment strategies.
Collapse
|
11
|
Michel M, Pratt JW. Anterior mediastinal nonseminomatous germ cell tumor with malignant transformation: a case report. ACTA ACUST UNITED AC 2005; 61:576-9. [PMID: 15590027 DOI: 10.1016/j.cursur.2004.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We report a case of a 21-year-old man who presented with the unusual symptoms of heart failure and was found to have an anterior mediastinal yolk sac tumor. METHODS A review of the literature using the Ovid search engine was performed. RESULTS The patient was treated with the current standard of neoadjuvant chemotherapy: bleomycin, etoposide, and cisplatin (BEP) with marked reduction in tumor size, followed by en bloc surgical resection. The final pathology revealed teratoma with malignant change: chondrosarcoma, adenocarcinoma, and poorly differentiated sarcoma. CONCLUSIONS This is a rare initial presentation of an anterior mediastinal germ-cell tumor with treatment consisting of neoadjuvant therapy and surgical resection. In addition, we present the adverse and extremely rare malignant degeneration of this tumor.
Collapse
Affiliation(s)
- Michael Michel
- Division of Cardiothoracic Surgery, Keesler Medical Center, Keesler Air Force Base, Biloxi, MS 39534, USA.
| | | |
Collapse
|
12
|
Huang HY, Ko SF, Chuang JH, Jeng YM, Sung MT, Chen WJ. Primary yolk sac tumor of the urachus. Arch Pathol Lab Med 2002; 126:1106-9. [PMID: 12204063 DOI: 10.5858/2002-126-1106-pystot] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pure yolk sac tumor is the most common malignant gonadal tumor of infants and toddlers. However, the majority of extragonadal germ cell tumors in the midline are either seminomas (germinomas) or teratomas, and pure yolk sac tumors account for only a small fraction of these lesions. To date, only 1 primary urachal pure yolk sac tumor has been reported in the literature. We describe another case, occurring in a 7-month-old male infant who presented with a rapidly enlarging intra-abdominal tumor with marked engorgement of the superficial venous plexus around the umbilicus. With periodic follow-up for 3 years following surgical extirpation of the tumor and adjuvant chemotherapy, this patient is still alive without evidence of disease. Notably, the glandular elements predominating in the frozen sections resulted in the initial misdiagnosis of the tumor as a urachal adenocarcinoma, although the entirely resected specimen revealed typical histologic patterns and Schiller-Duval bodies. Immunohistochemistry showed that the tumor cells were diffusely reactive to alpha-fetoprotein, alpha(1)-antitrypsin, and cytokeratin. Tumor cells were negative for p53 protein, but revealed overexpression for MDM2 protein. Flow cytometry demonstrated a diploid DNA content with S-phase being as high as 55.36%. This case emphasizes that pure yolk sac tumor can occur primarily in the remnant of the urachus in young children.
Collapse
Affiliation(s)
- Hsuan-Ying Huang
- Department of Pathology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University, Kaohsiung, Taiwan
| | | | | | | | | | | |
Collapse
|
13
|
Neiman RS, Orazi A. Mediastinal non-seminomatous germ cell tumours: their association with non-germ cell malignancies. Pathol Res Pract 1999; 195:589-94. [PMID: 10483591 DOI: 10.1016/s0344-0338(99)80010-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Mediastinal non-seminomatous germ cell tumors are unique tumors in that they are associated with both sarcomatous and hematologic neoplasms. This paper relates our experience at Indiana University with these tumors, and discusses the possible mechanisms of their occurrence, especially with respect to the hematologic neoplasms.
Collapse
Affiliation(s)
- R S Neiman
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianopolis 46202-5200, USA
| | | |
Collapse
|
14
|
Affiliation(s)
- C A Moran
- Department of Pathology, University of Alabama, Birmingham 35294, USA
| |
Collapse
|
15
|
Silverman JF, Olson PR, Dabbs DJ, Landreneau R. Fine-needle aspiration cytology of a mediastinal seminoma associated with multilocular thymic cyst. Diagn Cytopathol 1999; 20:224-8. [PMID: 10204106 DOI: 10.1002/(sici)1097-0339(199904)20:4<224::aid-dc8>3.0.co;2-c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Multiloculated thymic cysts are uncommon lesions that can be either acquired or associated with malignancies. This report describes the fine-needle aspiration (FNA) cytology of a mediastinal seminoma with prominent cystic change, confirmed by surgical pathology examination and ancillary studies performed on both the cytology and tissue specimens. The FNA cytology revealed clusters of malignant oval-to-polygonal-shaped cells with large oval nuclei possessing prominent nucleoli set in a pale-to-eosinophilic cytoplasm. These cells were surrounded by a dense lymphoid infiltrate along with a few noncaseating granulomas. The large malignant seminoma cells stained positive for placental alkaline phosphatase (PLAP) and negative for both low molecular and broad-spectrum cytokeratin. The differential diagnosis of malignancies associated with thymic cysts is presented. To the best of our knowledge, this is the first report of aspiration cytology of a mediastinal seminoma associated with a multilocular cyst.
Collapse
Affiliation(s)
- J F Silverman
- Department of Pathology, Allegheny University of the Health Sciences, Allegheny University Hospital, Pittsburgh, PA 15212-4772, USA.
| | | | | | | |
Collapse
|